With the deadline to enroll in a Medicare Advantage plan just two days away, there doesn’t seem to be any easy answers for patients like Larry Thompson.

At a Thursday press conference, Thompson said his wife has glaucoma and “what I don’t want to do is go to another doctor.”

He said his wife has been going to the same doctor for 10 years and the doctor knows what works and what doesn’t.

“We don’t want her starting over again with another physician,” Thompson said. “Continuity of care is critical . . . Will my wife go blind because of some administrative ruling by UHC? That’s wrong.”

Cardiologists in Norwalk and Norwich, oncologists in Bridgeport, and the entire Yale Medical Group was removed from UnitedHealthcare’s Medicare Advantage plan, according to Dr. Robin Oshman, president of the Fairfield County Medical Association.

Since UnitedHealthcare began dropping doctors about two months ago, Oshman said they haven’t received a straightforward answer about why UnitedHealthcare allegedly ended its relationship with an estimated 2,250 doctors from their network in Connecticut. Those doctors, according to Oshman, serve about 20,000 to 30,000 of the company’s 58,000 Connecticut patients.

Jennifer Pappas, a spokeswoman for UnitedHealthcare, said she could not confirm those numbers. She said the reconfiguration of the networks is based on geography, quality, and efficiency.

But physicians said finding out if your doctor is on the plan or off the plan isn’t as easy as calling or checking UnitedHealthcare’s website.

“If you go to the computer one week your doctor’s there, the next week they could be dropped,” Oshman said. “So it’s very confusing. It wasn’t done properly.”

The allegation by the two medical societies in the federal lawsuit is that UnitedHealthcare is dropping doctors who serve some of its sicker patients. Those patients end up costing the insurance carrier more money and may make it more difficult for it to receive a five star rating under the Affordable Care Act. The higher the rating, the more money the carrier will receive in federal reimbursements.

“Although no reason was provided for this unilateral termination, United’s motives are nonetheless clear: By terminating numerous physicians from the MA Networks, United seeks to stem financial losses occasioned by reduced federal payments under the Affordable Care Act,” the lawsuit claims.

Rep. Jonathan Steinberg, D-Westport, said what UnitedHealthcare was doing is wrong.

“The fact that they have not been forthcoming about the reason why doctors are being dropped makes one take the most cynical, suspicious attitude about what their motivations are,” Steinberg said. “I’ll be candid about this I believe that they are taking advantage of the Affordable Care Act and this borders on profiteering.”

He said getting rid of sicker patients undermines the Affordable Care Act, but if it works other insurance carriers may being following their lead.

Pappas said that the company is “absolutely not” making these changes to get rid of sicker patients. She said 80 percent of the Medicare population has at least one chronic condition and 60 percent have two or more chronic conditions.

“We have to be able to serve those with complex health care needs,” she said. At the end of the day “we still have one of the most robust networks in the state.”

But doctors who attended the press conference Thursday were skeptical.

“What they have done essentially is they’ve undercut doctors,” Dr. Bollepalli Subbarao, president of the Hartford County Medical Association, said. “They’ve betrayed the trust of the public and I think this has to stop.”

He said the two medical societies are in this battle for the long haul and while they might not “be as rich as UnitedHealth” they have the public behind them.

Lawmakers like Rep. Prasad Srinivasan, who also is a doctor and a member of the Hartford County Medical Association, said he’s had an hour-long conversation with senior officials from UnitedHealthcare. He said he left them with a list of questions he wanted answered and has not gotten any response back.

But he’s not alone. Attorney General George Jepsen and members of Connecticut’s congressional delegation have not received satisfactory answers to their questions, either.

“Two months into the story and nothing has really changed,” Srinivasan said. “And that is the frustrating part.”

While it’s frustrating for legislators, Oshman said there are some things they can do. They can insist on having network adequacy in the state of Connecticut. That means mandating the number of specialists and general practitioners in a given health insurance plan in each geographic part of the state to provide care to patients.

“Network adequacy should be defined by the state of Connecticut, not by CMS [Centers for Medicare and Medicaid Services], Medicare, or UnitedHealthcare. We know what’s best for our patients,” Oshman said. “It’s a local issue for the state and we should make that determination.”

Other things lawmakers can do to bring transparency to the issue is to require insurance carriers to disclose what benefits are covered under the plan and if the company is giving economic incentives to physicians to give more or less care to patients. They should have the right to appeal for treatment decisions and “they should have something called continuity of care.” She said that under continuity of care, a patient can request that a doctor continue treating them until the end of the patient’s contract with an insurance carrier.

Oshman said that if they are not successful in court, they will be launching an education campaign to make sure patients know about the continuity of care clause in their plans.

Pappas said UnitedHealthcare is reaching out to its patients by letter and telephone to let them know about the changes and continuity of care.

Comments

Archived Comment

posted by: JAM | December 5, 2013 4:34pm

ObamaCare has made major cuts to Medicare funding - particularly Medicare Advantage. This is an argument over money and slices of a smaller pie.
Perhaps someone should ask our Federal delegation why they voted for these cuts?